Legacy CA Student Registration Application Form 6-4A

Transcription

1 Chartered Professional Accountants of Ontario (The Institute of Chartered Accountants of Ontario) 69 Bloor Street East Toronto, ON M4W 1B3 Tel: Fax: Toll free: customerservice@cpaontario.ca Legacy CA Student Registration Application Form 6-4A Please read the Legacy CA Student Registration Information and Instructions guide before completing this application form. A Member or Student of the Chartered Professional Accountants of Ontario (registered name of The Institute of Chartered Accountants of Ontario) ( CPA Ontario ) has the right to privacy in respect of information of a personal nature that is unrelated to membership status or not required to be disclosed in respect of the fulfillment of CPA Ontario s self-regulatory responsibilities. This form is not to be completed by members of Accounting Bodies Outside of Canada or members of Other Ontario Accounting Designations. Such members must use the Internationally Trained Application Form or the Other Ontario Accounting Designation - Application for Assessment Form, respectively. CPA Ontario No.: (For internal use only) 1. Personal Data Have you ever registered with CPA Ontario in the past? If yes, please specify: Student Ambassador Program Professional Development course Ordered material Course credit assessment Registered Name (must appear exactly as written on legal documentation) Mr. Miss. Mrs. Ms. Surname Birth Date (mm/dd/yy): / / Given Names: Given Names Used: Mailing Address: City: Province: Country: Postal Code: Tel: Mobile: (required): Languages spoken: (other than English) Languages used when conducting business: (other than English) Employment Information Employer Name and Address: City: Province: Country: Postal Code: Tel: Fax: (required): Date Paid Employment Commenced in an Approved Training Office (mm/dd/yy): / / Was this employment opportunity secured through the Resume Portal? Yes No page 1 of 4 (Form_6_4A_WCAG) 04/2014

2 3. Total Amount of Fee Remittance Please select one of the following fee categories: I am registering under the Co-operative Degree classification pursuant to subsection 5.2 in Regulation 6-4. I am therefore remitting a total fee of $ which consists of the $ HST registration fee and the $ HST maintenance (renewal) of registration fee. I am registering under a category other than the Co-operative Degree classification. I am therefore remitting a total fee of $ which consists of the $ HST registration fee and the $ HST maintenance (renewal) of registration fee. MasterCard Visa HST# Credit Card Number: Expiry Date: / Company Cheque Personal Cheque To pay by cheque, record your full name or CPA Ontario number (if known) on the cheque and make it payable to: Chartered Professional Accountants of Ontario. I authorize CPA Ontario to charge the above credit card, if credit card payment information for the amount specified above has been provided. X / / Print Full Name of Cardholder Signature of Cardholder Date (MM/DD/YYYY) 4. CPA Ontario Use Only - Fees Due CPA Ontario No.: Education Code: Refund Required: $ ATO ID: Category Code: Fees Received: $ Registration Date: M M D D Y Y Date Received: M M D D Y Y Amount to be Billed: $ 5. Education Information If additional space is required, please attach a supplementary schedule. 4-Year, 120 credit-hour Degree or Equivalent Conferred (BComm, BA etc) Name of Academic Institution Year Convocated Month/Year 1st 2nd 6. Registration Classification Please SELECT ONLY ONE classification (A through F) below, to indicate the category under which you are applying for registration with CPA Ontario. A. Accredited Program/Stream: For co-op students, provide expected year of graduation: Program: Please refer to Schedule B in Regulation 6-4 for a listing of CPA Ontario s approved Accredited Programs/Streams. page 2 of 4 (Form_6_4A_WCAG) 04/2014

3 B. Co-operative Degree Program: Expected year of graduation: Program: Please refer to Schedule A in Regulation 6-4 for a listing of CPA Ontario s approved Co-operative Degree Programs. C. University graduate: Canadian Academic Institution Academic Institution Outside Canada D. Conditional (Part-time degree program student) Expected year of graduation: E. Mature Status F. Transfer from another provincial body (Please indicate name of body): Registered From: Have you written the Uniform Evaluation: Yes No Registered To: 7. To Be Completed By The Student To the Registrar: I apply for registration as a Student, in so doing, declare that it is my intention to qualify for, and to seek, admission to membership in CPA Ontario. In consideration of CPA Ontario granting and continuing such registration, I give the following undertakings: (a) to be governed, in my relations with CPA Ontario, by the Bylaws, Rules, Regulations, and Rules of Professional Conduct; and (b) to accept the direction and control of the Council in all matters relating to studies, practical experience, and discipline. Please read carefully to the end of this section before answering the following question. Have you ever: (a) been convicted of any criminal or similar offence under any Act of the Parliament of Canada, or of the legislature of any province of Canada, or under the laws or ordinances of any territory of Canada, or under the laws of any jurisdiction outside of Canada, OR (b) pleaded guilty to or been found guilty of a criminal offence but been discharged absolutely or upon conditions prescribed in a probation order under any Act of the Parliament of Canada, or of the legislature of any province of Canada, or under the laws or ordinances of any territory of Canada, or under the laws of any jurisdiction outside of Canada. NOTES: 1. In answering the above question you may answer NO if the proceeding(s) in which you were involved arose out of your operation of a motor vehicle and no penalty other than a fine or demerit points was imposed. 2. If your answer to the above question is YES, please provide full details on a separate sheet. Yes No I understand that the information provided herein is essential to CPA Ontario in determining my suitability for registration or reregistration as a Student in CPA Ontario and, accordingly, it is provided with the utmost good faith and with the knowledge that it will be so used and relied upon by CPA Ontario. I also understand that any false or misleading statement contained in my application for registration or re-registration may be used by CPA Ontario in any proceeding respecting the validity of my application or of my status as a Student in CPA Ontario. I have read and understood the requirements for registration as a Student under Regulation 6-4 and confirm that I have satisfied the registration criteria. I agree to submit to CPA Ontario all documentation requested and understand that these documents will be used in reviewing my application. I understand that my application is not considered complete until all documentation required by this application has been received by CPA Ontario. I declare that the above information and all other information given in this application is true and correct. X / / Signature Date (MM/DD/YYYY) page 3 of 4 (Form_6_4A_WCAG) 04/2014

4 8. To Be Completed By The Student s Employer This office/unit is eligible to train this Student having already received approval as an Approved Training Office. Name of business unit, if applicable, Student is to be trained in: This Student will be trained in the (please select the one that applies): External audit program Outside external audit program I certify that this individual is or will be employed full-time or part-time in my office/unit as a Student as of the date he/she has stated in the application. I recommend this individual as being of good character to be registered by CPA Ontario. X / / Print Name and CPA Ontario Member Number Signature of Training Principal Date (MM/DD/YYYY) page 4 of 4 (Form_6_4A_WCAG) 04/2014

5 Chartered Professional Accountants of Ontario (The Institute of Chartered Accountants of Ontario) 69 Bloor Street East Toronto, ON M4W 1B3 Tel: Fax: Toll free: customerservice@cpaontario.ca Legacy CA Student Registration Application Checklist In order for CPA Ontario to process your application for registration as a Legacy CA Student, please ensure that you have submitted all of the following: CPA Ontario s Academic Code of Conduct Fee remittance Proof of legal name Official academic institution transcript(s) OR proof of educational qualifications (such as an original letter of good standing confirming enrolment in a recognized accredited university program or co-op program). Please note that an official transcript is required from each academic institution at which courses have been completed. The following should be included, as applicable: CÉGEP/A Levels/college transcripts. If you cannot provide a transcript showing conferral of a degree, please provide a letter from the academic institution s Registrar s Office confirming that the degree requirements have been met and you will graduate at the next convocation ceremony. Application Form 6-4A (Parts 1 through 8 fully complete) Resume Required for Students registering under the Mature Student classification. Letter of good standing in a Provincial Body Required for Students registering under the Provincial Transfer classification. Letter of good standing in the Institute of Chartered Accountants of Bermuda Students Required for Bermuda Students. Letter of recommendation from the Approved Training Office in Bermuda Required for Bermuda Students. When your registration application has been received, CPA Ontario will send: an acknowledgement within one to two weeks of receipt. If documentation or other information remains outstanding, you will be notified in writing. After your registration application has been processed, CPA Ontario will send: a confirmation of registration; a confirmation of credit hour recognition; and a welcome package (LCASRAC_WCAG) 04/2014